Objective To explore the appl ication of submental island flaps in repairing pharyngeal fistula after total laryngectomy. Methods From July 2002 to February 2006, 9 cases of concomitant pharyngeal fistula (including 7 cases of laryngeal carcinoma and 2 cases of hypopharyngeal neoplasms) were repaired with submental island flaps after total laryngectomy. All patients were male and their ages were 52-71 years (mean 61.8 years). Pharyngeal fistula occurred 5-62 days (mean 14.7 days) after total laryngectomy. The diameter of medial pharyngeal fistula ranged from 1.9 cm to 4.1 cm. All patients failed to respond to conservative therapy for 25-46 days. The size of submental island flap was 2.5 cm × 2.4 cm to 4.6 cm × 4.0 cm. After the pharyngeal fistula were repaired with submental flap, the donor site were sutured directly. Results All of the nine submental flaps were survived and no local necrosis or wound infection occurred. Incision at donor site healed by first intention and no obvious scar formed. Fistula occurred 10 days after operation and was cured after symptomatic treatment in one patient who received radiotherapy before operation; other patients achieved the satisfactory results of one-stage repair. The gastric tube was pulled out 14 to 22 days after operation, all of the patients have no sense of swallow obstruction. Nine patients were followed up for 10-38 months (mean 27 months). The ppearance of neck was satisfactory. Conclusion Because of its short distance, abundant blood supply, convenient operation and minimal donor-site morbidity, the submental island flap is a good alternative mthod in repairing pharyngeal fistula.
ObjectiveTo explore the effectiveness of pedicled thoracoacromial artery perforator (TAAP) flap for pharyngocutaneous fistula repair after total laryngectomy and radiotherapy. MethodsBetween February 2012 and January 2015, TAAP flap was used to repair pharyngocutaneous fistula after total laryngectomy and radiotherapy in 8 patients. The eight patients were male, aged from 46 to 72 years (mean, 51.8 years). The disease duration was 8-62 months (mean, 27.5 months). Fistula size ranged from 4.0 cm×2.5 cm to 6.0 cm×4.0 cm and the skin defect size ranged from 4.0 cm×3.0 cm to 6.0 cm×4.0 cm. The flap size ranged from 7.0 cm×4.0 cm×0.3 cm to 9.5 cm×6.0 cm×0.5 cm. The length of pedicle was (8.3±0.5)mm. The distance from pivot point of flap to central point of recipient site was (94.5±1.9) mm. ResultsAll 8 flaps survived and all incisions healed smoothly. The hospitalization time was 7-14 days (mean, 9.6 days). The barium meal examination showed no fistula or stenosis. The patients were followed up 8-42 months (mean, 28.5 months). During follow-up, the neck appearance was good, and no fistulas or stenosis occurred. Only linear scars were observed at the donor sites, pectoralis major muscle function was normal in all patients. ConclusionPharyngocutaneous fistula should be repaired as early as possible after total laryngectomy. TAAP flap is suitable for the reconstruction of pharyngocutaneous fistula after total laryngectomy.